North Korea came under criticism from Amnesty International last week for the dismal state of the country’s health care system. While North Korea (the Democratic People’s Republic of Korea or DPRK) has a well-earned reputation for disregarding the interests of its people – malnutrition is common and many of the country’s people face serious health problems arising from disease and poverty – the government has faced increasing economic difficulties that have undermined the state run (virtually everything in North Korea is state run) health care system to an appalling degree.
The Amnesty International report provides truly horrific details and testimonials from North Koreans. The introduction to the Amnesty report clearly lays out the vast difference between North Korea’s claims on its provision of health care and the reality:
Interviews with North Koreans depict a country that professes to have a universal (free) health care system but in reality struggles to provide even the most basic service to the population. Health facilities are rundown and operate with frequent power cuts and no heat. Medical personnel often do not receive salaries, and many hospitals function without medicines and other essentials. As doctors have begun charging for their services, which is illegal under North Korea’s universal health care system, the poor cannot access full medical care, especially medicines and surgery.
Importantly, the report recognizes that fact that the dismal health care system in North Korea is “in large part due to failed or counterproductive government policies.”
Compare this against the assessment of Margaret Chan, Director General of the U.N.’s World Health Organization. Following a visit to the Country in April 2010, Dr. Chan observed:
Now based on what I have seen, I can tell you they have [a health care system] that most other developing countries would envy.
For example, DPRK has no lack of doctors and nurses, as we have seen in other developing countries where most of their doctors have migrated to other places. But DPRK has enough doctors and nurses, they have a very elaborate health infrastructure, starting from the central to the provincial to the district level….
People in the country do not have to worry about a lack of financial resources to access care….
[W]alking is quite well observed in that country, and I suggest that is why I didn’t see many obese people.
Chen’s comments were heavily criticized when reported and rightly so. The lack of “obese people” is due to chronic food shortages in the country, exacerbated by the government’s opposition to letting farmers sell their crops for profit. A large percentage of the populace falls below international standards of malnutrition and an estimated one million North Koreans died of starvation and starvation-related diseases in the 1990s. The country needs massive amounts of international food aid every year to avoid a repetition of starvation.
As for the rest of Chan’s observations, Fox News summarized parts of the Amnesty report which detailed how doctors “sometimes [perform] barbaric amputations without anesthesia and [work] by candlelight for payment in cigarettes, in hospitals lacking essential medicine, heat and power.” Doctors work without pay from the government and supposedly free medical services are routinely denied to North Koreans unless they can pay the doctors illicitly in cigarettes, alcohol or money.
While many developing countries have very poor health care systems, North Korea seems unlikely to elicit envy from any of them.
However, far from being embarrassed, WHO seems ready to double down on their gaff. When Amnesty issued their report, WHO spokesman Paul Garwood criticized the Amnesty report as outdated and unscientific, being based on comments from “people who aren’t in the country.”
Imagine that. The dictatorial North Korean government tightly monitors and controls access to its citizens by NGOs and foreign media and has a disturbing habit of killing or sentencing to labor camps those citizens who criticize its policies. I wonder why Amnesty had to rely on testimonials by people who had managed to escape the brutal regime.
While Amnesty International has it flaws and biases, WHO’s attack on the Amnesty report is a ridiculous denial of reality.
WHO’s knowledge of the North Korean health care system obviously extends beyond Chan’s two and a half days of dog and pony shows designed to make North Korea look good. After all, they have an extensive cooperative program with North Korea. They, more than any international organization, should know the poor state of North Korea’s health care system. This makes it all the more disturbing that WHO is so eager to dismiss testimonials on North Korea’s health care system by those who lived with it every day until they were lucky enough to get out of the country in one piece.
The comments by WHO officials about North Korea go far beyond the usual U.N. tendency to resist criticizing or portraying its member states in a bad light. Indeed, since they embarrass WHO and deflect vital attention away from the health needs of the North Korean people, the only plausible beneficiary of the comments is the North Korean regime. Why would WHO wish to defend the North Korean government?
This entire episode provides further evidence of just how far WHO has wandered from its mission of the “attainment by all peoples of the highest possible level of health.” The policies and repression of the North Korean government actively undermine WHO’s mission and the organization should not shy away from criticizing the DPRK and its policies that cause so much harm. As international health experts Roger Bate and Karen Porter conclude in ConUNdrum: The Limits of the United Nations and the Search for Alternatives, it is time for WHO to do some fundamental self-assessment.